Takeuchi Hayato, Iwamoto Kazuhide, Mukai Mao, Fujita Tomoaki, Tsujino Hitoshi, Iwamoto Yoshihiro
Department of Neurosurgery, Yamashiro Public Hospital.
Neurol Med Chir (Tokyo). 2014;54(3):231-5. doi: 10.2176/nmc.cr2012-0376. Epub 2013 Nov 8.
Pathological laughing, one subgroup of psuedobulbar affect, is known as laughter inappropriate to the patient's external circumstances and unrelated to the patient's internal emotional state. The authors present the case of a 76-year-old woman with no significant medical history who experienced pathological laughing after subarachnoid hemorrhage (SAH) due to rupture of an aneurysm, which was successfully treated with craniotomy for aneurysm clipping. In the acute stage after the operation she suffered from severe vasospasm and resulting middle cerebral artery territory infarction and conscious disturbance. As she regained consciousness she was afflicted by pathological laughing 6 months after the onset of SAH. Her involuntary laughter was inappropriate to the situation and was incongruent with the emotional state, and she could not control by herself. Finally the diagnosis of pathological laughing was made and treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI), effectively cured the symptoms. Her pathological laughing was estimated to be consequence of infarction in the right prefrontal cortex and/or corona radiata, resulting from vasospasm. To the authors' knowledge, this is the first report of pathological laughing after aneurysmal SAH. The authors offer insight into the pathophysiology of this rare phenomenon. Effectiveness of sertraline would widen the treatment modality against pathological laughing.
病理性发笑是假性延髓情绪的一个亚组，表现为与患者外部环境不相称且与患者内在情绪状态无关的笑。作者报告了一例76岁女性病例，该患者无重大病史，因动脉瘤破裂导致蛛网膜下腔出血（SAH）后出现病理性发笑，通过开颅夹闭动脉瘤成功治疗。术后急性期，她发生了严重的血管痉挛，导致大脑中动脉供血区梗死和意识障碍。SAH发病6个月后，随着意识恢复，她出现了病理性发笑。她的不自主笑与情境不符，与情绪状态不一致，且无法自控。最终确诊为病理性发笑，使用选择性5-羟色胺再摄取抑制剂（SSRI）舍曲林进行治疗，有效缓解了症状。据作者所知，这是首例关于动脉瘤性SAH后病理性发笑的报告。作者深入探讨了这一罕见现象的病理生理学。舍曲林的有效性将拓宽病理性发笑的治疗方式。
